It has been more than 160 years since the link between sewage-polluted drinking water and cholera was first established. And yet from December 2014 to August 2016, more than 17,000 people were hospitalized due to cholera in Kenya. It is a stark reminder that inequalities persist, and that sanitation and clean drinking water are still of crucial importance if Kenya is to achieve the Sustainable Development Goals (SDGs).

Today, some 5.6 million Kenyans have no toilet whatsoever, and only Busia County has been certified free of people defecating in the open – an indicator of extreme poverty. Other counties, including Isiolo and Siaya, have made good progress towards becoming ‘open defecation-free,’ though there is work to do before the whole country achieves that status.

A report entitled TheTrue Cost of Poor Sanitation estimated that Kenya’s economic losses due to poor sanitation amount to Ksh. 57 billion per year. This report, launched during the Tokyo International Conference on African Development (TICAD), hosted by Kenya in August of this year, based this estimate on the costs due to lost productivity from sanitation-related illness, coupled with the cost of treatment. These costs are borne by taxpayers as well as patients themselves.

Alongside the economic costs is the reality for girls and women, for whom the lack of a private and safe toilet is a matter of both dignity and safety.

The lack of toilets affects school attendance. There is clear evidence that toilets keep children healthy and in school. When schools lack private and hygienic toilets, many adolescent girls stay home during menstruation, missing several school days each month.

And women who deliver their babies at health centres with no or poor sanitation find themselves – and their newborns – at risk of infection.

Now, more than ever, we need to respond to United Nations Deputy Secretary-General Jan Eliasson’s ‘Call to Action on Sanitation’. He urges all actors – governments, civil society, businesses and international organizations – to commit to measurable action and mobilize resources to rapidly increase access to basic sanitation.

In rural areas, the top priority must be to eliminate open defecation. It is critical that all county governments earmark dedicated sanitation budgets, and implement time-bound ‘open defecation-free’ action plans. The Counties of Garissa, Isiolo, Kitui and Siaya are to be commended for taking these first steps.

In urban areas, while there is no magic bullet to tackle this complex problem, there are examples of innovative solutions that show promise – such as pay-per-use public toilets, and collection and composting systems. If Kenya does not prioritize the necessary infrastructure, it risks losing its footing along the way towards continued economic development and prosperity.

Addressing the adequate disposal of human waste and improving sanitation facilities remain a high priority for UNICEF and the World Bank, and it is vital for Kenya’s success on the world stage and in achieving the SDGs. Along with other development partners, we are committed to supporting the Government of Kenya in realizing the health benefits, economic opportunities and – most importantly – the human dignity that proper sanitation provides.

Diariétou Gaye is the World Bank Country Director for Kenya, and Werner Schultink is the UNICEF Representative in Kenya.